The Comprehensive Guide to CoQ10 Benefits for Women

Welcome to our comprehensive guide on Coenzyme Q10 (CoQ10), a vital nutrient that's making waves in the health and wellness sphere. This guide is particularly tailored for women, focusing on the potential benefits of CoQ10, from boosting fertility to heart health and beyond.

We'll delve into the science behind CoQ10, exploring its role in the body and how it might help with conditions like high blood pressure and migraines. We'll also discuss its potential to mitigate the side effects of statins, a common medication for high cholesterol.

Whether you're curious about the effectiveness of CoQ10, looking for ways to improve your heart health, or seeking to understand the potential side effects, this guide is for you. So, let's embark on this journey of discovery together, shall we.

Understanding CoQ10 and Its Role in the Body

Coenzyme Q10, or CoQ10, is a vital nutrient that plays a significant role in our bodies. It's a powerhouse that aids in energy production, acts as an antioxidant, and is essential for the health of our vital organs. However, understanding CoQ10 and its role in the body goes beyond just knowing what it is. It's about getting to grips with how it works, why it's important, and how its levels can impact our health.

In this section, we'll delve deeper into the world of CoQ10, exploring its function, the effect of coenzyme levels on our health, and the role of coenzyme in clinical trials. We'll also discuss how our bodies manage to maintain a balance between the two forms of CoQ10, ubiquinone and ubiquinol. Let's embark on this journey to better understand this crucial nutrient.

What is CoQ10?

CoQ10, also known as coenzyme Q10, is a naturally occurring nutrient found in every cell of our bodies. It's a vital component of our cellular machinery, playing a key role in the production of energy. This compound is synthesised within our cells' powerhouses, the mitochondria, where it aids in the creation of adenosine triphosphate (ATP), the primary energy source for our cells.

CoQ10 is also recognised for its antioxidant properties. As an antioxidant, it helps to neutralise harmful free radicals that can cause cellular damage. This protective role is particularly important in maintaining the health of our vital organs such as the heart, liver, and kidneys, where the highest levels of CoQ10 are found.

However, as we age, the level of coenzyme Q10 in our bodies tends to decrease. This decline can be associated with various health conditions, making it an important nutrient to monitor. The total amount of CoQ10 in the body is approximately 2000 mg, and our daily nutritional intake is estimated at 3-6 mg/day.

CoQ10 supplementation is considered safe and well-tolerated, with an acceptable daily intake of about 720 mg/d for a person weighing 60 kg. Despite its importance, the efficacy of CoQ10 supplementation is often questioned due to its low and incomplete absorption.

In summary, CoQ10 is a vital nutrient that plays a significant role in energy production and antioxidant protection within our bodies. Its importance becomes even more pronounced as we age, making it a key focus in maintaining overall health.

How does CoQ10 work in the body?

CoQ10, or coenzyme Q, plays a crucial role in our bodies. It's primarily involved in the production of ATP, a molecule that acts as the main energy source for cell growth and maintenance. This is particularly important for high-energy organs like the heart and liver, where the level of coenzyme is naturally highest.

The role of coenzyme Q doesn't stop at energy production. It's also a potent antioxidant, helping to protect our cells from damage caused by harmful free radicals. This is vital for maintaining overall health and preventing diseases associated with oxidative stress.

Interestingly, our bodies can convert CoQ10 between two forms: ubiquinone and ubiquinol. Ubiquinol, the reduced form, is the most prevalent in our blood circulation. This ability to switch forms enhances the effect of coenzyme Q, making it a versatile player in our body's biochemistry.

However, the level of coenzyme Q in our bodies isn't constant. It tends to decrease with age, and lower levels have been associated with various health conditions. This has led to clinical trials of coenzyme Q supplements, aiming to understand their potential benefits and efficacy.

CoQ10 and Its Potential to Improve Fertility

The potential of CoQ10 to enhance fertility is a topic of growing interest. This naturally occurring antioxidant may play a significant role in improving both female and male fertility. As we delve into this section, we'll explore how CoQ10 might boost fertility and the scientific evidence supporting these claims.

From clinical trials to systematic reviews, the effectiveness of CoQ10 in fertility enhancement has been put under the microscope. The results, while promising, call for further research. Let's delve into the details.

Click here to discover how our "His & Hers Fertililty Bundle" with CoQ10 and Myo-inositol can help improve your chances of conception.

How CoQ10 may improve fertility

CoQ10, a naturally occurring antioxidant, has been linked to potential fertility improvements. As we age, our bodies produce less CoQ10, which can lead to a decline in egg quality and quantity. This is a significant factor in the decrease of female fertility over time. However, supplementing with CoQ10 may help to counteract this decline.

The antioxidant properties of CoQ10 are believed to protect eggs from oxidative damage, which can negatively impact their quality. This is crucial as high-quality eggs are essential for successful fertilisation and a healthy pregnancy.

In men, CoQ10 may improve sperm quality, activity, and concentration. Oxidative damage can also affect sperm health, leading to reduced sperm count and poor sperm quality. By increasing antioxidant protection, CoQ10 supplementation could potentially enhance male fertility as well.

While the evidence is promising, it's important to note that the effectiveness of CoQ10 in improving fertility is still under investigation. More extensive clinical trials and systematic reviews are needed to establish a definitive link.

If you're considering CoQ10 supplementation for fertility support, it's recommended to consult with your doctor or a healthcare professional. They can provide personalised advice based on your individual health needs and circumstances.

Clinical trials and reviews on CoQ10 and fertility

CoQ10's potential to enhance fertility has been the subject of numerous clinical trials and systematic reviews. Here are some key findings:

A study by Akarsu et al.^1 found a correlation between CoQ10 concentrations in follicular fluid and the success rate of assisted reproductive techniques.

Ben-Meir et al.^2 discovered that CoQ10 could restore oocyte mitochondrial function and fertility during reproductive aging.

A systematic review by Florou et al.^3 explored whether CoQ10 supplementation could improve fertility outcomes in women undergoing assisted reproductive technology procedures.

These studies suggest that CoQ10 may improve fertility, but it's important to note that the evidence is not yet conclusive. More extensive research is needed to establish the effectiveness of CoQ10 as a fertility aid. Always consult your doctor before adding any supplement to your regimen.

CoQ10's Role in Heart Health

CoQ10, a naturally occurring nutrient, plays a crucial role in heart health. Its antioxidant properties and ability to support cellular energy production make it a potential ally in the fight against heart disease. This section will delve into the specifics of how CoQ10 may contribute to heart health, its potential benefits for heart failure patients, and its possible protective effects on the heart. It's important to remember that while CoQ10 shows promise, it should not replace traditional treatments for heart conditions. Always consult with your doctor or a healthcare professional before starting any new supplement regimen.

How CoQ10 may improve heart health

CoQ10, a vitamin-like compound, has been linked to potential benefits for heart health. It's been studied for its potential to improve conditions such as heart failure, atherosclerosis, and coronary artery disease. The high energy requirements of cardiac cells make them particularly susceptible to low levels of CoQ10, which is where supplementation may come into play.

Research^4 suggests that CoQ10 may support heart health by reducing oxidative stress, a factor that can contribute to heart disease. It's also been found to potentially aid recovery after heart attacks, easing symptoms of heart failure, and helping to regulate blood pressure.

However, it's important to note that while some studies have shown promising results, others have found the effects of CoQ10 on specific cardiovascular risk factors to be less impressive. Therefore, it's not currently recommended for routine use in people with coronary heart disease.

Despite this, the potential of CoQ10 to improve heart health cannot be overlooked. It's a promising area of research, and further studies may help to clarify the role of CoQ10 in heart health. As always, it's recommended to consult with a healthcare professional before starting any new supplement regimen.

CoQ10 and heart failure

CoQ10 has shown promise in the management of heart failure. Research indicates that individuals with heart failure often have low levels of CoQ10. This deficiency can impact the heart's ability to pump blood effectively, leading to symptoms such as shortness of breath and swelling in the legs.

Supplementing with CoQ10 may help to alleviate these symptoms. Studies^5 have found that CoQ10 can reduce fluid in the lungs, making breathing easier, and decrease swelling in the legs. It may also enhance exercise capacity in people with heart failure, which is crucial for overall health and wellbeing.

However, it's important to note that the use of CoQ10 for heart failure remains a topic of debate. While some studies have reported positive effects, others have found no significant impact. Therefore, it's not recommended to use CoQ10 as a standalone treatment for heart failure.

Before starting any new supplement regimen, it's always best to consult with your doctor or healthcare provider. This is especially true for individuals with heart conditions, as CoQ10 may interact with other medications.

CoQ10's potential to protect the heart

CoQ10, a natural compound with antioxidant properties, has been studied for its potential to protect the heart. It's believed that this compound may be beneficial to cardiac cells, which have high energy requirements and are significantly affected by low levels of CoQ10.

The antioxidant properties of CoQ10 may help reduce oxidative stress, a key factor in heart disease. This could potentially lead to improvements in heart function and a reduced risk of hospitalisation.

However, it's important to note that the effects of CoQ10 on specific cardiovascular risk factors, such as blood pressure and blood sugar control, have not been found to be significant.

While some studies suggest that CoQ10 supplementation can lead to improvements in heart health, the evidence is not strong enough to support its routine use in people with coronary heart disease.

Despite this, the potential of CoQ10 to protect the heart should not be dismissed outright. More research is needed to fully understand its benefits and potential applications in heart health.

Take our quiz to find the best MyOva supplement for you!

Take our quiz

CoQ10 and Its Potential to Reduce Migraines

CoQ10, a naturally occurring compound, has been gaining attention for its potential benefits in reducing migraines. This section will delve into how CoQ10 may help alleviate the frequency and intensity of migraines, offering a glimmer of hope for those who regularly suffer from these debilitating headaches. We'll also explore the role of oxidative stress in migraines and how CoQ10 may help combat this.

How CoQ10 may reduce migraines

CoQ10, a natural compound with antioxidant properties, has been linked to potential migraine relief. This connection is believed to be due to CoQ10's role in the production of adenosine triphosphate (ATP), a substance crucial for energy production and muscle contraction.

Studies^6 suggest that regular consumption of CoQ10 may reduce migraines' frequency and intensity. This is particularly beneficial for women who often experience migraines as part of their menstrual cycle.

However, it's important to note that while CoQ10 may reduce migraines, it doesn't necessarily alleviate the pain associated with them. The compound's primary function is to decrease the frequency and duration of these severe headaches, not to act as a painkiller.

CoQ10 is generally safe to use, with minor side effects such as gastrointestinal discomfort and headaches being uncommon. However, it's always recommended to consult with a healthcare professional before adding it to your daily routine.

The role of oxidative stress in migraines

Oxidative stress is a significant player in the onset of migraines. It's a state where harmful free radicals in the body outnumber the antioxidants, leading to cell damage. This imbalance can trigger inflammation and oxidative stress, which are believed to be key factors in the development of migraines.

CoQ10, a potent antioxidant, plays a crucial role in combating this oxidative stress. It helps neutralise harmful free radicals, thereby potentially reducing the frequency and severity of migraines.

Moreover, CoQ10 is essential for the production of adenosine triphosphate (ATP), a molecule that provides energy to our cells. Low levels of ATP have been linked to migraines, suggesting that CoQ10 supplementation may help by boosting energy production in the brain cells.

However, it's important to note that while CoQ10 may reduce migraines, it doesn't necessarily alleviate the pain associated with them. More research is needed to fully understand the role of CoQ10 in migraine management.

CoQ10 and High Blood Pressure

The relationship between CoQ10 and high blood pressure is a topic of interest in the medical community. CoQ10, a compound naturally produced by the body, has been studied for its potential to lower blood pressure.

While some studies suggest promising results, the evidence is not yet conclusive. It's important to understand the potential benefits and risks before considering CoQ10 as a supplement for managing high blood pressure.

How CoQ10 may help with high blood pressure

Research^7 suggests that CoQ10 may promote the widening of blood vessels, which can help to lower blood pressure. This is achieved by increasing the availability of nitric oxide, a molecule that plays a crucial role in blood vessel health.

However, it's important to note that the relationship between CoQ10 and blood pressure isn't fully understood yet. Some studies have shown promising results, with CoQ10 supplementation leading to a reduction in systolic blood pressure. But these findings are not consistent across all studies.

It's also worth mentioning that the effects of CoQ10 on blood pressure may not be immediate. In some cases, it may take up to 12 weeks to see any significant changes. This suggests that CoQ10 may be more effective as a long-term strategy for managing high blood pressure, rather than a quick fix.

While the potential of CoQ10 to lower blood pressure is promising, it's crucial to consult with your doctor or a healthcare professional before starting any new supplement regimen. This is especially true for those already on blood pressure medication, as CoQ10 may interact with these drugs.

CoQ10 and blood pressure medication

CoQ10 is known to interact with certain medications, including those for blood pressure. It's crucial to understand these interactions before considering CoQ10 supplementation. For instance, CoQ10 may work alongside blood pressure medications to further lower blood pressure. In some clinical studies, adding CoQ10 supplements allowed patients to reduce the doses of their blood pressure medication.

However, it's important to note that more research is needed in this area. If you're currently on medication for high blood pressure, it's advised to consult your healthcare provider before starting CoQ10. It's not recommended to stop taking your regular medication without professional advice.

CoQ10 may also interact with blood-thinning medications. There have been reports suggesting that CoQ10 could make medications such as warfarin less effective at thinning the blood. If you're on blood thinners, it's crucial to discuss with your healthcare provider before starting CoQ10.

Furthermore, CoQ10 may reduce the heart-related side effects of betaxolol, a beta-blocker medication used to treat glaucoma. However, it doesn't make the medication any less effective.

CoQ10 and Statin Side Effects

Navigating the world of statins and their side effects can be a daunting task. This section aims to shed light on the potential benefits of CoQ10 in managing these side effects.

CoQ10, a naturally occurring compound, has been linked to alleviating muscle pain, a common side effect of statins. However, it's essential to approach this potential solution with caution and always consult your healthcare provider.

Understanding statin side effects

Statin drugs, often prescribed to individuals with high cholesterol, are known to have a few side effects. One of the most common complaints from patients is muscle pain. This discomfort can range from a mild ache to a debilitating weakness, making everyday tasks challenging.

Another side effect that patients often report is fatigue. This can be particularly troublesome as it can affect a person's ability to function optimally throughout the day.

It's also worth noting that statins can cause digestive issues. Some patients experience upper belly pain, loss of appetite, and loose stool. These side effects, while not life-threatening, can significantly impact a person's quality of life.

Lastly, some patients may experience mood changes, such as irritability or restlessness. While these side effects are less common, they can still be distressing for the individual.

It's crucial to speak to your doctor if you're experiencing any of these side effects while taking statin drugs. They can provide advice and potential solutions to help manage these issues.

How CoQ10 may help with statin side effects

Statin drugs, commonly prescribed to manage high cholesterol, often come with a side effect that patients find hard to bear - muscle pain. This discomfort can range from a mild ache to a debilitating pain, making everyday tasks a challenge.

CoQ10, a naturally occurring compound in our bodies, has been studied for its potential to alleviate this side effect. The connection between CoQ10 and statins is intriguing. Statins, while effective in lowering cholesterol, also reduce the natural levels of CoQ10 in the body.

Supplementing with CoQ10 can help restore these levels. Some studies^8 suggest that this could, in turn, reduce the muscle pain associated with statin treatment. A 2018 review found that CoQ10 supplementation reduced statin-induced muscle pain, weakness, cramps, and tiredness.

However, it's important to remember that supplement use should be individualised and vetted by a health care professional. If you're considering adding CoQ10 to your routine to manage statin side effects, it's crucial to speak to your doctor first.

While CoQ10 is generally considered safe with minimal side effects, it may interact with other medications. Always consult with your healthcare provider before starting any new supplement regimen.

CoQ10 Supplements and Dosage

Navigating the world of CoQ10 supplements and understanding the appropriate dosage can be a daunting task. With a myriad of options available and varying recommendations, it's essential to have a clear understanding of what to look for. This section will delve into the specifics of CoQ10 supplements and the recommended dosage, providing you with the necessary knowledge to make an informed decision.

Remember, while CoQ10 has been studied in clinical trials and systematic reviews, it's always best to speak to your doctor or health care provider before starting any new supplement regimen. They can provide personalised advice based on your health needs and conditions.

Choosing the right CoQ10 supplement

Choosing the right CoQ10 supplement can be a bit of a minefield, given the variety available on the market. However, there are a few key factors to consider that can help you make an informed decision.

Firstly, it's important to note that CoQ10 supplements come in two forms: ubiquinone and ubiquinol. Ubiquinol is the most abundant form in your body and is generally more potent and bioavailable than ubiquinone. This means it's more easily absorbed by your body, making it a more effective choice for supplementation.

Secondly, the form of the supplement can also impact its absorption. Soft gels are often recommended as they can enhance the bioavailability of CoQ10, ensuring your body gets the maximum benefit.

Lastly, always remember to speak to your doctor or health care provider before starting any new supplement regimen. They can provide guidance based on your specific health needs and conditions.

Recommended dosage of CoQ10

The recommended dosage of CoQ10 varies greatly, with studies using doses ranging from 50 to 1,200 milligrams in adults. However, it's important to note that the amount of CoQ10 found naturally in foods is significantly lower than that found in supplements.

For adults aged 19 and above, the suggested dose for CoQ10 supplementation is between 30 to 200 mg daily. Soft gels are often better absorbed than capsules or other preparations, making them a popular choice.

It's also worth noting that CoQ10 is fat-soluble, meaning it's best absorbed with a meal containing fat. Some studies even suggest that it may work better if taken at night.

However, there's no one-size-fits-all dosage. It's crucial to speak to your doctor or a dietitian to determine the right dosage for you. Remember, different supplement brands might have different ingredients and strengths, so always follow the instructions on the bottle.

Potential Side Effects of CoQ10

While CoQ10 is generally considered safe, it's important to be aware of potential side effects. These can range from mild discomforts such as digestive issues and insomnia, to more serious concerns like interactions with certain medications. It's crucial to understand these potential risks before incorporating CoQ10 into your health regimen.

In some cases, CoQ10 may not be suitable for everyone. Certain individuals, such as those with diabetes or high blood pressure, should exercise caution. Always consult with a healthcare professional before starting any new supplement, including CoQ10.

Common side effects of CoQ10

Digestive issues: CoQ10 can cause digestive problems such as abdominal pain, loss of appetite, and diarrhoea.

Nausea and heartburn: These are common side effects that can occur when taking CoQ10.

Insomnia: Some people may experience difficulty sleeping after taking CoQ10.

Skin reactions: Itchy skin and rashes are potential side effects of CoQ10.

Mood changes: Some people may feel annoyed or upset when taking CoQ10.

Headaches and dizziness: These are also common side effects of CoQ10.

Potential interaction with medications: CoQ10 may interact with certain medications such as blood thinners, insulin, and some cancer treatments. Always speak to your doctor before starting any new supplement regimen.

Who should avoid taking CoQ10?

CoQ10, while beneficial, isn't for everyone. Certain individuals should exercise caution or avoid it altogether. For instance, children under 18 should not take CoQ10 unless under the supervision of a healthcare provider. The effects on this age group are not fully understood, and it's better to err on the side of caution.

People with diabetes should also be wary. CoQ10 may lower blood sugar, potentially leading to insulin resistance or high blood sugar if not monitored. If you're diabetic, it's crucial to speak to your doctor before starting a CoQ10 regimen.

Those on certain medications should also avoid CoQ10. It can interfere with blood thinners like warfarin, and some types of cancer chemotherapies. The interaction could potentially reduce the effectiveness of these treatments.

Moreover, CoQ10 may interact with blood pressure medications, potentially causing a drastic drop in blood pressure. If you're on medication for high blood pressure, consult your healthcare provider before taking CoQ10.

Final Thoughts on CoQ10 Benefits for Women

In conclusion, the benefits of CoQ10 for women are manifold. From potentially improving fertility to reducing migraines, and from supporting heart health to mitigating high blood pressure, CoQ10 is a versatile supplement. It's important to remember that while CoQ10 shows promise in many areas, it's not a magic bullet.

It's crucial to maintain a balanced diet, regular exercise, and consult with a healthcare professional before starting any new supplement regimen. The effectiveness of CoQ10 can vary based on individual health conditions and needs. Lastly, while CoQ10 supplementation may help alleviate certain conditions, it should not replace conventional treatments.

Always speak to your doctor before making any changes to your health care routine. Remember, your health is your wealth, and it's worth investing in.

Health Disclaimer:

The information provided in the blog post is intended for informational purposes only. It should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare professional for guidance on your specific condition.

Although Coenzyme Q10 may offer potential benefits for women individual results may vary. It is important to note that scientific research on its effectiveness is ongoing, and more evidence may be needed regarding their long-term effects or safety.

Before considering cinnamon or any other supplement, we strongly recommend discussing it with your doctor or healthcare provider. They can provide personalised advice based on your medical history, current medications, and overall health.

It is crucial to remember that dietary supplements are not subject to the same regulations as prescription medications in the United Kingdom. Therefore, it is important to thoroughly research potential benefits and risks and to choose products from reputable manufacturers.

While we strive to provide reliable and up-to-date information, we cannot guarantee the accuracy or completeness of the content presented in this blog post. We do not assume any liability for any consequences arising from the use of the information provided.

Ultimately, your health and well-being are best served by actively engaging with a qualified healthcare professional who can guide you on your wellness journey. They can help you make informed decisions about treatment options, including the potential use of Coenzyme Q10.

Remember, you are your own best advocate, and open dialogue with your healthcare provider is key to making informed decisions about your healthcare.

Take our quiz to find the best MyOva supplement for you!

Take our quiz

References:

1. Akarsu S, Gode F, Isik AZ, Dikmen ZG, Tekindal MA. The association between coenzyme Q10 concentrations in follicular fluid with embryo morphokinetics and pregnancy rate in assisted reproductive techniques. J Assist Reprod Genet. 2017 May;34(5):599-605. doi: 10.1007/s10815-017-0882-x. Epub 2017 Feb 9. Erratum in: J Assist Reprod Genet. 2017 May;34(5):607. PMID: 28185121; PMCID: PMC5427661.

2. Ben-Meir A, Burstein E, Borrego-Alvarez A, Chong J, Wong E, Yavorska T, Naranian T, Chi M, Wang Y, Bentov Y, Alexis J, Meriano J, Sung HK, Gasser DL, Moley KH, Hekimi S, Casper RF, Jurisicova A. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell. 2015 Oct;14(5):887-95. doi: 10.1111/acel.12368. Epub 2015 Jun 26. PMID: 26111777; PMCID: PMC4568976.

3. Florou P, Anagnostis P, Theocharis P, Chourdakis M, Goulis DG. Does coenzyme Q10 supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials. J Assist Reprod Genet. 2020 Oct;37(10):2377-2387. doi: 10.1007/s10815-020-01906-3. Epub 2020 Aug 7. PMID: 32767206; PMCID: PMC7550497.

4. Zozina VI, Covantev S, Goroshko OA, Krasnykh LM, Kukes VG. Coenzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem. Curr Cardiol Rev. 2018;14(3):164-174. doi: 10.2174/1573403X14666180416115428. PMID: 29663894; PMCID: PMC6131403.

5. Al Saadi T, Assaf Y, Farwati M, Turkmani K, Al-Mouakeh A, Shebli B, Khoja M, Essali A, Madmani ME. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2021 Feb 3;(2)(2):CD008684. doi: 10.1002/14651858.CD008684.pub3. PMID: 35608922; PMCID: PMC8092430.

6. Shoeibi A, Olfati N, Soltani Sabi M, Salehi M, Mali S, Akbari Oryani M. Effectiveness of coenzyme Q10 in prophylactic treatment of migraine headache: an open-label, add-on, controlled trial. Acta Neurol Belg. 2017 Mar;117(1):103-109. doi: 10.1007/s13760-016-0697-z. Epub 2016 Sep 26. PMID: 27670440.

7. Gutierrez-Mariscal FM, de la Cruz-Ares S, Torres-Peña JD, Alcalá-Diaz JF, Yubero-Serrano EM, López-Miranda J. Coenzyme Q10 and Cardiovascular Diseases. Antioxidants (Basel). 2021 Jun 3;10(6):906. doi: 10.3390/antiox10060906. PMID: 34205085; PMCID: PMC8229886.

8. Qu H, Guo M, Chai H, Wang WT, Gao ZY, Shi DZ. Effects of Coenzyme Q10 on Statin-Induced Myopathy: An Updated Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2018 Oct 2;7(19):e009835. doi: 10.1161/JAHA.118.009835. PMID: 30371340; PMCID: PMC6404871.